Methaemoglobinaemia and paralysis of the hemi-diaphragm in a leprosy patient

Leprosy Mailing List – October 18th, 2008

Ref.: Methaemoglobinaemia and paralysis of the hemi-diaphragm in a leprosy patient.
From: Satheeka Kamaladasa, Sri Lanka


Dear Dr Noto,

Dr Settinayake has kindly given me your e-mail address to discuss about some complications in a patient with lepromatous leprosy.

A 35-year-old patient was admitted to the ward with fever and a macular papular rash of 3 days duration. He was a diagnosed patient with lepromatous leprosy with multiple lesions and had been treated with the multi-drug therapy for multibacillary (MB) patients for 1 month duration.

While in the ward he became dyspnoeic, cyanosed and the arterial blood gases showed hypoxemia. Patient was transferred to the ICU, and MB therapy was stopped suspecting a dapsone hypersensitivity. Patient was noticed to have mild icterus and the air entry on the R base of the lung was reduced. Investigations showed increased retic count, methaemoglobinaemia and elevated liver enzymes.

Chest X-ray showed elevated R hemidiaphgram with hardly any inflammatory shadows. Ultra sound scan showed reduced movement of the R hemidiaphgram. Awaiting Fluroscopy. At this stage diaphgramatic paralysis due to involvement of the phrenic nerve was considered.

Whether this could be explained by a leprosy reaction?

Or can you put all these due to dapsone hypersensitivity syndrome?

Patient is on steroids and anti leprosy therapy has been omitted. I would value expert opinion about the explanation for his of respiratory problem. Whether it is related to a leprosy reaction or its treatment?

Physians & neurologists have seen the patient & have excluded other pulmonary pathologies & nerological causes & cardiac causes.

Thanking.

Yours sincerely,

Dr Satheeka Kamaladasa
Consultant Dermatologist
& Senior Lecturer in Medicine
Dept Of Medicine
Faculty of Medicine
University of Sri Jayawardenapura
Sri Lanka